Provider Demographics
NPI:1356313365
Name:CLAYTON, ROBERT W III (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:CLAYTON
Suffix:III
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 AIMEE RD
Mailing Address - Street 2:
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-9615
Mailing Address - Country:US
Mailing Address - Phone:318-336-2220
Mailing Address - Fax:318-336-6060
Practice Address - Street 1:241 AIMEE RD
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334-9615
Practice Address - Country:US
Practice Address - Phone:318-336-2220
Practice Address - Fax:318-336-6060
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN029650AP02167367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00082801Medicaid
MS050584209COtherMS BLUE CROSS
LA1396575Medicaid
MS430001921Medicare ID - Type UnspecifiedMS MEDICARE
LA1396575Medicaid
MS050584209COtherMS BLUE CROSS